At War with Terror

The suicidal foreigners who launched passenger-laden missiles at such domestic symbols of our strength as the World Trade Center and the Pentagon, not only killed thousands and scared tens of millions, but suddenly miniaturized the terror of Oklahoma City.

As with all cities "martyred" by war, the initial terror left us yearning for the safety of belonging. We found it in the selfless courage of public safety officers and in a patriotic defiance of our alien enemy. Our cynicism about public servants quickly converted into a blind trust. We even began to trust each other - except for Arabic-looking foreigners - as we had not done for half a century.

We pledged to fight terrorism as both a "war" (against "evil" nations) and a crime (against "evil" persons). We launched a post-Cold War "conventional" war, with UK and USA air forces, indigenous ground forces, and a global, if leaky, freeze of enemy assets. We soon added enough US ground forces to suffer our first casualties in "friendly fire" and to feed the historic Afghan xenophobia - built by generations of suffering from terrorizing foreigners. Did we employ terror to cure madness?

Despite early mention of deploying police forces in Afghanistan someday, nothing was ready when the Taliban collapsed and its opposition, meeting in Germany, feared foreign police might employ terror to cure madness. We thought the opposite.

By detaining unindicted suspects, investigating "suspicious" domestic groups, monitoring phone calls of suspects and their lawyers, and holding and questioning people because of their national heritage, were we at risk of using terror to cure madness?

President Bush told the United Nations we would present our evidence of crimes for consideration by an international tribunal. Three days later, he authorized secret military tribunals for non-citizens accused of terrorism, here and abroad. He gave the Secretary of Defense extraordinary powers to suspend habeus corpus and establish ad hoc trial rules, with review only by the President. Were we risking employing terror to cure madness? Which constitutional guarantees of life, liberty and the pursuit of happiness can we surrender with reasonable safety from an imperial government and reasonable safety from terrorists?

National security, our president said, transcends military security. In that context, he urged Russia's president to replace military action against Chechan "terrorism" with diplomacy and Israel's prime minister to do the same about Palestinian "terrorism." All three, though, trusted war-making more than peace-making - and the US military demonstrated why that trust was justified.

When anthrax suddenly appeared in unusual number and our mail became hand-held launchers for bioterrorism, we groped for safety in a murky uncertainty. We did what any nation would do when trinkets and food packets become booby traps, when sidewalk cafes, shopping malls and discos become firing ranges. We surrendered our civil liberties in the hope of protecting ourselves against the terror. We breached medical confidentiality on the basis that everyone had a need to know in order to protect themselves.

The number of anthrax victims was small and lethality was low, but unexpected new events and daily contradictions terrorized us. Officials warned of the greater risk of nuclear or chemical attacks, or of more infectious agents, like smallpox or plague. Old fears bred new ones, blurring into a generalized anxiety.

Terrorism requires randomness and unpredictability. Spirit counts, not body counts, measure its success. Repeating reliable information, respectfully listening to the quiver in people's questions, giving trustworthy answers promptly, letting people know how to protect themselves and help others - all build trust. Being honest about what we do not know, suggesting where to get more information and giving emotional support all build trust. False reassurance and exhortations to spend our way out of fear diminish trust.

Benjamin Rush, the father of American psychiatry and a signer of the Declaration of Independence, terrorized many a patient with his incendiary poultices and exsanguinating leeches, with his moralizing to patients as they hung in the stocks, but produced more terror than cures.

We physicians constantly apply science to individual patients in unique circumstances, so we understand the frustrations of governments that must make decisions with far less science and far more misinformation and disinformation. Physicians try to do less harm with our cure than the disease itself - perhaps a worthy credo for government.

Federal, state and local personal and community health, law enforcement and education have begun to put turf issues aside and work together to provide necessary services and disseminate consistent and honest information. There is more public and private collaboration on planning and providing information and services. Public funding and organization are a bit better. Health agencies now provide more reliable, consistent and timely information and professional education on-line - and acknowledge what they do not know.

The sagging economy should not stifle this progress. Now is the time to end the long neglect of health services. Public health, mental health and public safety resources have often worked at cross purposes. Now is the time to fix that - and to fix the sorely stressed emergency health services system. That would build trust and counter terror.

Should an "economic stimulus package" help restore domestic security by mitigating years of neglect of public and personal health, medical research and education, affordable housing, public transportation and energy conservation? Rather than shrink Medicaid, should we extend it and increase payment to cover providers' costs? Should we guarantee health care coverage for workers and the recently unemployed?

Could this strange new war help return health care responsibility from employers to patients? With a subsidy or tax relief, could we move health care from the company store to the market place? If employers passed health care savings on to consumers, they could increase demand and restore jobs. That would be coming together against terrorism.

Ed_Rudin@macnexus.org